Effects of a Multidisciplinary Approach to Improve Volume of Diagnostic Material in CT-Guided Lung Biopsies

Abstract

BackgroundRecent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2.DesignThis retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block.ResultsBiopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9–1.1 cm) in 2007 to 2.5 cm (2.3–2.8 cm) in 2012 (P<0.0001). The improvement was statistically significant for each individual radiologist. During the same time, the rate of pneumothorax requiring chest tube placement decreased from 15% to 7% (P = 0.065). No other major complications were identified. The proportion of tumor within the biopsy material was similar at 28% (23%–33%) and 35% (30%–40%) for 2007 and 2012, respectively. The number of cases with at least two blocks available for testing increased from 10.7% to 96.4% (P<0.0001).ConclusionsThe effect of this multidisciplinary strategy to CT-guided lung biopsies was effective in significantly increasing tissue volume and number of blocks available for advanced diagnostic testing.

Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing

“…Our results showed that putting the core specimens in two separately numbered formalin containers rather than one formalin container was more efficient in tissue preservation. It was in consistent with Ferguson et al reporting multidisciplinary approach to optimize tissue volume in CT-guided TTNB ( 18 ). Although needles of lower gauge and increased number of core tissue increase specimen amount, diagnostic tissue loss is a major problem during repetitive cutting at the microtome.…”

Applications Used to Increase the Accuracy Rate of Transthoracic Lung Biopsies Performed in Centers for Molecular Biological Diagnosis and Targeted Therapy for Oncology

“…For example, when needle thickness is increased from 19G to 18G, tissue sample collection increases by 49%, and when sample length is increased from 10.9 to 12.6, sufficient tissue for molecular testing increases from 85% to 98% [ 16 ]. In another study, when the biopsied sample size was increased, the rates of malignancy diagnosis increased from 62% to 76.8% [ 17 ].…”

Physician attitudes and prevalence of molecular testing in lung cancer

“…Although there is scant data directly comparing molecular testing success rates with and without the ROSE protocol, a meta-analysis conducted by Schmidt and colleagues concluded that ROSE improved the adequacy rate of fineneedle aspiration cytology by 12%. 32,33 Given that molecular profiling depends on both the absolute and relative amount of tumor cells present in the sample, the ROSE protocol likely enhances the procedural success rate and reduces the need for repeat and subsequent biopsies.…”